Comparison of the pleiotropic effect of atorvastatin and rosuvastatin on postmenopausal changes in bone turnover: A randomized comparative study

BACKGROUND

Statins are the first-line treatment for dyslipidemia, which is a major modifiable risk factor for atherosclerotic cardiovascular disease. Studies have shown that in addition to the beneficial lipid-lowering effect, statins also exhibit a number of pleiotropic effects that may find application in other diseases, including osteoporosis. This study aimed to assess the effect of statins on bone turnover, as measured by the concentration of bone turnover markers, and to compare the effect of atorvastatin as a lipophilic statin and rosuvastatin as a hydrophilic statin.

METHODS

This study included 34 postmenopausal women aged < 65 years with newly diagnosed dyslipidemia requiring statin therapy. Patients were randomly assigned to receive a statin drug. Statins were initiated at standard doses of 5 to 10 mg of rosuvastatin and 20 mg of atorvastatin. The levels of C-terminal telopeptide of type I collagen as a bone resorption marker and N-terminal propeptide of procollagen type I as a marker of bone formation, lipid concentrations and other biochemical parameters were assessed at baseline and after 6 and twelve months of treatment.

RESULTS

There were no statistically significant differences between the levels of bone turnover markers before and 6 months after statin implementation (P > .05) - for all patients or subgroups according to statin use. Analysis of the results showed that after 12 months, there was a statistically significant decrease in N-terminal propeptide of procollagen type I concentration in all subjects (P = .004). By statin subgroup, a statistically significant decrease in N-terminal propeptide of procollagen type I was observed only in patients receiving rosuvastatin (P = .012) and not in those receiving atorvastatin (P = .25). Moreover, changes in bone turnover markers did not correlate with changes in lipid concentrations.

CONCLUSIONS

These results may indicate the superiority of atorvastatin over rosuvastatin in inhibiting adverse changes in bone turnover in postmenopausal women. Confirmed by studies involving a larger population, the observed differences might find particular applications in clinical practice, and the choice of atorvastatin over rosuvastatin for women could be considered in the early postmenopausal period to reduce the risk of osteoporosis and subsequent osteoporotic fractures.

Interleukin-6 Family of Cytokines in Cancers

Nine soluble ligands [interleukin-6 (IL-6), interleukin-11 (IL-11), leukemia inhibitory factor (LIF), oncostatin M (OSM), ciliary neurotrophic factor (CNTF), cardiotrophin-1 (CT-1), cardiotrophin-like cytokine, interleukin-27 (IL-27), and interleukin-31] share the ubiquitously expressed transmembrane protein-glycoprotein-130 beta-subunit (gp130) and thus form IL-6 family cytokines. Proteins that may be important for cancerogenesis, CT-1, IL-11, IL-27, LIF, OSM, and CNTF, belong to the superfamily of IL-6. Cytokines such as IL-6, IL-11, and IL-27 are better investigated in comparison with other members of the same family of cytokines, eg, CT-1. Gp130 is one of the main receptors through which these cytokines exert their effects. The clinical implication of understanding the pathways of these cytokines in oncology is that targeted therapy to inhibit or potentiate cytokine activity may lead to remission in some cases.

Impact of the SARS-CoV-2 Vaccination Program on Presenteeism and Absenteeism among Healthcare Workers in Poland

BACKGROUND

There is sufficient scientific literature on the effectiveness of registered vaccines in preventing SARS-CoV-2 infection, but research on the impact of the COVID-19 vaccination program on social and economic aspects is lacking. In connection with the above, this study aimed to assess the impact of vaccinations on presenteeism and absenteeism among healthcare professionals in the workplace caused by the COVID-19 pandemic.

METHODS

A post-marketing, cross-sectional survey-based study was carried out on a sample of 736 actively employed healthcare professionals. Among them, 215 individuals (29.21%) were unvaccinated (control group). The study group consisted of 521 vaccinated respondents, with 52.97% being women and 47.03% men. A self-administered questionnaire was developed and delivered online to the target population group of healthcare workers.

RESULTS

A significant association (p < 0.01) was observed between the number of doses of the COVID-19 vaccine received and presenteeism among the respondents. Among the unvaccinated respondents (2.30 ± 1.19) or those vaccinated with only one dose of the SARS-CoV-2 vaccine (2.16 ± 1.11), the COVID-19 pandemic had a significantly higher impact on work performance compared to individuals vaccinated with three doses of the vaccine (1.19 ± 1.11). Moreover, a significant association was found (p = 0.0265) between the number of workdays missed (over the last twelve months) due to COVID-19-related sick leave and the number of doses of the COVID-19 vaccine received. The number of workdays missed due to COVID-19 sick leave was lowest in the group vaccinated with three doses (2.00 ± 6.75) and highest in the unvaccinated group (5.32 ± 16.24).

CONCLUSIONS

Our results clearly show that the widely implemented national COVID-19 vaccination program brings tangible benefits both in medical and economic terms. The extent of reducing absenteeism and presenteeism caused by the coronavirus disease depended on the number of vaccine doses administered.

Pharmacovigilance practice among pediatric neurologists from Poland and Germany

OBJECTIVES

To compare the pediatric neurologists' knowledge, practice, and barriers to the pharmacovigilance (PV) process in Poland and Germany.

METHODS

The research tool was an online anonymous questionnaire on Google Forms e-mailed to pediatric neurologists from Poland and Germany.

RESULTS

The questionnaires were handed out to 830 pediatric neurologists and 371 expressed their consent to participate in the study. Most of the neurologists were familiar with the definition of PV and adverse drug reactions (ADRs). Only 34.10% of pediatric neurologists from Poland, and 38.88% from Germany believe that many ADRs are preventable and almost most of them believe it is necessary to report ADRs from children with epilepsy. Unfortunately, in opposite to this knowledge, only 37.79% of respondents from Poland and 40.32% from Germany felt co-responsible for reporting ADRs. The main reason for the neurologists not to report ADRs was a conviction that reporting ADRs would be an additional burden generating extra work.

CONCLUSION

There is no big difference between the practice of PV by pediatric neurologists in Poland and Germany. System-regulated PV stabilization in the country translates into the practice of maintaining PV. Monitoring the safety of pharmacotherapy and knowledge of risks associated with ADRs should be included in the curricula of academic neurologics courses.

Serum Asprosin Correlates with Indirect Insulin Resistance Indices

BACKGROUND AND OBJECTIVES

Insulin resistance is a major contributor to the development of type 2 diabetes and can be assessed using indirect indicators calculated from non-invasive tests. Asprosin is a recently discovered adipokine with a postulated effect on glycemic regulation. This study aimed to investigate the correlation between serum asprosin levels and insulin resistance indices. The correlation between circulating asprosin and obesity indices was also investigated.

MATERIALS AND METHODS

A total of 50 non-diabetic patients with obesity and 50 healthy volunteers were studied. Laboratory data, including circulating asprosin and anthropometric data, were collected. The following insulin resistance indices were calculated: triglyceride-glucose index (TyG), TyG-neck circumference (TyG-NC), TyG-neck circumference to height ratio (TyG-NHtR), TyG-waist circumference (TyG-WC), TyG-waist to height ratio (TyG-WHtR), TyG-body mass index (TyG-BMI), and the ratio between triglycerides and high-density cholesterol (TG/HDLc). The obtained data were analyzed separately for males and females.

RESULTS

Asprosin concentrations were significantly higher in obese patients (p < 0.001). Asprosin concentrations positively correlated with body mass index (p < 0.001, r = 0.8 in females and r = 0.8 in males), waist circumference (p < 0.001, r = 0.73 in females and r = 0.81 in males), and all tested indices of insulin resistance. The strongest correlation was observed for TyG-BMI (p < 0.001, r = 0.78 in females and r = 0.81 in males). Circulating asprosin was higher in females (p < 0.001).

CONCLUSIONS

Asprosin can be considered a marker of obesity and insulin resistance.

Effects of PCSK9 inhibitors on metabolic-associated fatty liver disease: a short review

Metabolic-associated fatty liver disease (MAFLD), previously known as non-alcoholic fatty liver disease, is a significant epidemiological problem and a well-known cardiovascular risk factor. The increasing number of cases creates the need for new therapeutic methods aimed at improving patient outcomes. Recent studies have highlighted the relationship between MAFLD and proprotein convertase subtilisin/kexin type 9 (PCSK9). Based on the available data, PCSK9 inhibitors appear to have beneficial effects in patients with MAFLD, and they may be a treatment option in the future. Further research is necessary to better evaluate the efficiency of PCSK9 inhibitors in MAFLD treatment.

Association between Compliance with COVID-19 Restrictions and the Risk of SARS-CoV-2 Infection in Poland

During the coronavirus disease 19 (COVID-19) pandemic it has become very important to comply with preventive measures. We aimed to assess compliance with applicable restrictions and to explore the links between the level of compliance and the risk of COVID-19. This cross-sectional study included Polish adults who were asked to complete a validated questionnaire. The study period was from 1 November 2020 to 31 January 2021 and a computer-assisted web interview method was chosen to perform the survey. The study involved 562 women and 539 men. COVID-19 was reported in 11.26% of participants. A good level of compliance with the sanitary restrictions was reported for 38.87% of participants, an average level of compliance for 47.96%, and a low level of compliance for 13.17%. A reduced risk of COVID-19 was associated with the following preventive measures: regular use of protective masks, social and physical distancing in public places, regular use of hand sanitizers with high ethanol content, and the use of disposable gloves in public places. Our survey revealed satisfactory public compliance with the pandemic restrictions. Sanitary and epidemiologic measures to prevent the pandemic were shown to be adequate and effective.

The Mental Health of Poles during the COVID-19 Pandemic

BACKGROUND

The SARS-Cov-2 pandemic has had a profound impact on all aspects of life in the global population, causing above other, psychological problems.

AIMS

The objective of this study was to evaluate the mental health of the Poles during the COVID-19 pandemic.

METHODS

A prospective, cross-sectional web-based survey design was adopted. The study horizon was from 1 June 2021, to 31 December 2021. An anonymous, standardized questionnaire was disseminated electronically by means of social media among Polish adults. The following tests were performed: Depression, Anxiety, and Stress Scale (DASS-21), and the Insomnia Severity Index (ISI).

RESULTS

A total of 1306 individuals completed the survey. Of the participants, 77.79% were female at a mean age of 34.89 ± (14.79), 62.25% had higher education, and 56.43% were employed. The prevalence of depression, anxiety, stress, and sleep disturbances in this sample were as follows: 50.38%, 43.49%, 61.26%, and 44.74%, respectively. Poor self-estimated health status, the presence of comorbidities, and regular use of nicotine significantly increased the risk of any of the analyzed psychiatric symptoms and sleep disorders. The depression level was significantly associated with age, living alone, health status, and the use of nicotine. Moreover, the level of anxiety was significantly associated with age and health status. The level of stress depended on gender, age, health status, use of nicotine, and being vaccinated against SARS-CoV-2. Sleep disturbances depended on age, health status, the presence of comorbidities, and regular use of drugs.

CONCLUSIONS

The Polish population manifested numerous psychological symptoms during the COVID-19 pandemic. There is a need to afford psychological support to them and ensure their mental health.

Impact of the COVID-19 pandemic and lockdown on mental health among the general population in Poland and on the availability of psychological support

The objective of this paper was to assess the impact of the COVID-19 pandemic on the mental health of Poles and the availability of psychiatric and psychological support during the pandemic. A prospective, cross-sectional web-based survey design was adopted. It was carried out on a sample of 1080 Polish citizens above 18 years old. The majority of Poles (70%) experienced symptoms of mental disorders during the COVID-19 pandemic. Sleep disturbance (63.79%), anxiety (48.79%), low mood for most of the day (44.63%), sadness, tearfulness (41.29%), and concentration disorders (35.93%) were the mental disorder symptoms reported most often by the survey subjects. To reduce the potential acute and long-lasting effects of the COVID-19 pandemic on mental health, decision-makers of the Polish health system should implement stepped multilevel and multi-target psychological support services.

Comparison of Perceived Weight Discrimination between Polish and German Patients Underwent Bariatric Surgery or Endoscopic Method versus Conservative Treatment for Morbid Obesity: An International Multicenter Study

Objectives: The aim of this study was to compare the level of discrimination among patients with obesity living in Poland and Germany. Methods: This was a retrospective cross-sectional international multicenter survey study including 564 adult participants treated for morbid obesity at selected healthcare facilities in Germany (210 patients) and in Poland (354 patients). Discrimination was evaluated using a custom-made questionnaire based on the related literature. Results: The level of obesity discrimination did not differ between German and Polish patients (p = 0.4282). The presence of obesity was reported to be associated to a large or a very large extent with the feeling of social exclusion and discrimination by 46.63% of German participants and 42.09% of Polish ones (p = 0.2934). The mean level of discrimination related to the lack of employment was higher in patients who underwent bariatric surgery or endoscopic method than in those who underwent conservative treatment (for Germany: 2.85 ± 1.31 (median, 3) vs. 2.08 ± 1.31 (median, 1), p = 0.002; for Poland: 2.43 ± 1.15 (median, 2) vs. 1.93 ± 1.15 (median, 1), p = 0.005). The level of discrimination was associated with sex, age, the degree of obesity, and treatment-related weight loss (p < 0.05). Conclusions: Our findings confirm that obesity significantly affects the social and economic well-being of patients. There is a great need to reduce weight stigma and to take measures to alleviate the socioeconomic and psychological burden of obesity.

Impact of bariatric surgery on depression, anxiety and stress symptoms among patients with morbid obesity: international multicentre study in Poland and Germany

BACKGROUND

There is a need to investigate how adopting different strategies for treating obesity in different countries in the European Union affects the psychological well-being of patients.

AIMS

The aim of this study was to perform a comparative evaluation of psychiatric symptoms (depression, anxiety and stress) in patients undergoing bariatric surgery versus patients receiving conservative treatment for morbid obesity in Poland and Germany.

METHOD

A multicentre international prospective cohort study with 155 patients who underwent bariatric surgery and 409 patients who received conservative weight reduction treatment. Evaluation of the psychiatric symptoms was carried out for each patient at baseline and after 12 months of active treatment using a standardised Depression Anxiety Stress Scale questionnaire (DASS-21) questionnaire.

RESULTS

After 12 months of active treatment, the level of psychiatric symptoms (depression, anxiety and stress) significantly decreased in both groups of patients: surgically treated versus conservatively treated patients from Poland and also from Germany. The median change in level of psychiatric symptoms among patients from both countries was significantly higher among surgically treated patients compared with conservatively treated patients (Poland P < 0.0001; Germany P < 0.0001). Improvements in the patient's mental health as a consequence of treatment were dependent on the specific strategy for treating obesity adopted in the analysed countries, the percentage of total weight loss and on gender.

CONCLUSIONS

The use of bariatric surgery in both Poland and Germany compared with non-surgical treatment for obesity resulted in more measurable benefits in the form of a decrease in psychiatric symptoms (depression, anxiety and stress) and reduction in body weight.

Assessment of the Impact of the COVID-19 Pandemic on the Pro-Health Behavior of Poles

The SARS-CoV-2 virus pandemic has exerted enormous impacts on individuals’ lifestyle, economics and social life. The aim of the study was to assess the impact of the COVID-19 pandemic on health-promoting behaviors of a sample of the Polish population, including dietary supplementation, physical activity, eating habits, and the implementation of preventive vaccinations. Within the scope of a survey, data was collected from 1101 adult respondents residing in Poland (862 women and 239 men). An anonymous questionnaire prepared based on the scientific literature was used as a research tool. The survey was conducted during the second wave of COVID-19 using the CAWI (Computer—Assisted Web Interview) method by disseminating the questionnaire using selected social media. We found that, during the COVID-19 pandemic, the respondents were more likely to maintain healthy eating habits and use dietary supplementation; however, the majority engaged in physical activity less frequently and had a sedentary lifestyle. Most felt no need to undergo preventive influenza vaccinations. The COVID-19 pandemic significantly increased the health awareness of the analyzed group from the Polish population. However, the obtained results are not fully satisfactory; therefore, there is a need to promote a healthy lifestyle and pro-health behaviors as part of social campaigns.

The Impact of Health Policy on Patients' Awareness of the Risks Associated with Obesity: An International Multicenter Study in Poland and Germany

BACKGROUND

Recent studies indicate that the treatment of obesity is unsuccessful. The cause of this situation is that patients are not sufficiently educated about therapeutic methods and the health consequences of not treating obesity. Moreover, obesity prevention strategies differ significantly between EU countries.

OBJECTIVE

The primary aim of this study was to examine and compare the level of obesity-related knowledge and illness perception among obese patients from Poland and Germany.

METHODS

A prospective cross-sectional international multicentre study was conducted. The study included 564 subjects above 18 years old (210 German patients and 354 Polish patients) with obesity. A validated custom-made questionnaire was used to evaluate obesity-related knowledge. Patient illness perception was evaluated using Polish and German language versions of the standardized Brief Illness Perception Questionnaire (B-IPQ).

RESULTS

Obese patients from Germany had significantly higher level of obesity-related knowledge than patients from Poland (22.01 ± 4.68 vs 19.17 ± 6.59, p<0.0001). Obesity-related knowledge was associated with the patient's education, patient participation in therapeutic educational programs, patient's perception of the illness, age and the number of healthcare professionals involved in the patient's treatment process.

CONCLUSION

The level of obesity-related knowledge among both Polish and German patients is unsatisfactory. This study suggests that health education is required to facilitate informed choices and support the use of cognitive approaches educating patients on the health consequences of obesity.

A Comparison Between the Therapeutic Effect of Metformin Alone versus a Combination Therapy with Insulin in Uncontrolled, Non-Adherence Patients with Type 2 Diabetes: Six Months Follow-Up

PURPOSE

The study aimed to compare the metabolic effects of an intensive dose of metformin alone among non-adherence patients with type 2 diabetes versus in combination with insulin among adherence patients.

METHODS

The prospective cohort study was carried out on a sample of 140 patients above 18 years old, divided into two groups. The first group (n=70) was recommended metformin monotherapy in an intensive dose of 2-3 g/day, whereas the second group (n=70) was prescribed metformin (1-2g/day) in combination with insulin. FPG, HbA1c, BMI, blood pressure, TC, TG, HDL-C, LDL-C, creatinine, and eGFR were measured for each patient at baseline and after a follow-up of 6 months of active treatment.

RESULTS

After six months of active treatment using monotherapy with an intensive dose of metformin, only 11.43% of patients achieved the target levels of HBA1c below 7%. In the group of patients treated using a combination of metformin with insulin, after six months of active treatment, 45.72% achieved HBA1c levels below 7% (p<0.0001). Compared with an intensive dose of metformin alone, the combination of insulin and metformin was associated with improved glycemic control (change of fasting blood glucose: 2.49 mmol/l vs 1.30 mmol/l, p=0.0016). Metformin use alone, as compared with insulin, was associated with a significant increase in HDL-C (+0.03 mmol/l vs -0.14 mmol/l, p=0.0485). Increased baseline obesity and increased baseline glycemia were the factors related to the likelihood of failing to achieve the target levels for HbA1c.

CONCLUSION

Metformin proved to be more effective in controlling hyperglycemia when combined with insulin therapy. Our study shows how many health benefits loss patients who, despite systematic diabetes education, do not agree to change their treatment in the form of adding a second drug, including insulin.

Impact of patient knowledge on hypertension treatment adherence and efficacy: A single-centre study in Poland

Introduction: Recent studies show that treatment of arterial hypertension is unsuccessful. This is due to the patients' insufficient knowledge of about the therapeutic methods and the consequences of not treating arterial hypertension. Objectives: The aim of the study was to evaluate the patients' knowledge concerning therapeutic options, prophylaxis, and complications of arterial hypertension. The study also assessed the effect of such knowledge on hypertension treatment adherence and efficacy. Patients and Methods: The survey included 488 patients (250 female and 238 male), aged over 18 years, diagnosed with and treated in outpatient and inpatient settings at selected healthcare institutions in Poland. A custom-made questionnaire, based on references on this subject, was the key tool in the present study. Information about the course of the disease and evaluation of hypertension treatment efficacy was based on the patients' medical records. Results: The study found that 54.7% of the subjects had good knowledge about arterial hypertension, 40.0% had average knowledge, and 5.3% had poor knowledge. The extent of knowledge about the disease was significantly dependent on the level of education and the place of receiving medical care (p< 0.05). Good knowledge was significantly associated with controlled blood pressure, number of antihypertensive drugs used, frequency of hospitalization, as well as with medication adherence, and healthy lifestyle behaviours (p< 0.05). Conclusions: More than half of the patients presented good knowledge but a large group still had poor knowledge, especially patients with a low level of education and with hypertension treated at a general practitioner's clinic. The results of our study clearly show that knowledge about arterial hypertension affects medication adherence and healthy lifestyle behaviours and improves hypertension treatment efficacy.

Does metabolically healthy obesity exist? A 32-year-old man with BMI 78 kg/m2 - to treat or not to treat?

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Effect of Different Blood-Pressure-Lowering Regimens on the Blood Pressure Control among Hypertensive Patients Treated in Hospital Conditions

BACKGROUND

Scientific references lack sufficient amount of data on analyses of the reasons for hospital admissions or assessment of efficacy of arterial hypertension treatment at hospitals.

OBJECTIVES

The aim of the study was to evaluate the efficacy of antihypertensive drug therapy on the blood pressure control among hospitalized hypertensive patients. Methodology. A cross-sectional retrospective study consisted of 204 patients aged 18-65 years admitted to the hospital due to hypertension between January 2018 and December 2018. The study was based on analysis of electronic records, obtained from the medical database of the selected healthcare facility.

RESULTS

As a result of the treatment applied at the hospital, 65.19% of the patients achieved the desired degree of blood pressure normalization (≤130/80 mmHg). Vast majority of the patients during their stay at the ward would receive three or more hypertensive drugs (63.73%). The most frequently prescribed antihypertensive drug combinations included bitherapies such as diuretics + ACEI and ACEI + β-blockers and tritherapy such as diuretics + β-blockers and calcium channel antagonists and diuretics + ACEI and ARBs. The highest blood-pressure lowering effects were observed among patients receiving combination therapy of a ACEI, a diuretic, and a ARBs. Tritherapy induced a significant mean reduction of inpatients`s SBP compared with bitherapy (p=0.0001).

CONCLUSION

During their hospital stay, vast majority of patients (65.19%) achieved normal values of blood pressure, mostly owing to combined treatment with several hypertensive drugs. Efficacy of the most frequently used combinations of hypertensive drugs in normalizing arterial pressure varies.

The impact of high‑density lipoprotein on oxidant-antioxidant balance in healthy elderly people

INTRODUCTION    There is an inverse relationship between high‑density lipoprotein cholesterol (HDL-C) levels and the risk of atherosclerosis. OBJECTIVES    The aim of the present study was to assess the oxidant-antioxidant balance in elderly people with different concentrations of HDL-C. PATIENTS AND METHODS    A total of 541 people aged 60 years or older were examined, of whom 90 individuals with no acute or severe chronic disorders had their waist circumference, body mass index, percentage of body fat, and blood pressure measured. Fasting and 120‑minute glycemia was determined in an oral glucose tolerance test, following which 15 patients with type 2 diabetes were excluded. Fasting plasma levels of lipids, total antioxidant status, and thiobarbituric acid-reacting substances (TBARS), as well ast the activity of erythrocyte superoxide dismutase 1 (SOD‑1) were assessed. Based on HDL-C levels, participants were divided into the high HDL‑C group (≥40.0 mg/dl and ≥50.0 mg/dl for men and women, respectively; n = 50) and the low HDL‑C group (<40.0 mg/dl and <50.0 mg/dl for men and women, respectively; n = 25). RESULTS    The groups did not differ in terms of age, blood pressure, body mass index, percentage of body fat, and glucose concentration. The high HDL‑C group had lower waist circumference (P <0.02) and lower triglyceride concentrations (P <0.00001). Increased TBARS levels (P <0.0005) was observed in the low HDL‑C group. There were no differences in SOD‑1 activity and total antioxidant status between the groups. CONCLUSIONS    HDL-C levels, which are known to reflect the antiatherogenic activity of HDL, including antioxidant properties, may indicate increasing oxidative stress in healthy elderly individuals.

Compliance Among Adolescents with Arterial Hypertension

BACKGROUND

The term "compliance" means the degree to which the patient's behavior, applying medication or certain lifestyle changes, is consistent with arrangements communicated to him by a doctor or other healthcare professional. Literature indicates that the degree of adherence to medical recommendations for hypertensive patients is unsatisfactory, making it the main cause of the low effectiveness of antihypertensive therapy.

OBJECTIVES

The aim of the study was to assess the compliance of adolescents in the field of pharmacological and non-pharmacological methods of hypertension treatment.

MATERIAL AND METHODS

The study included 62 patients (20 women, 42 men) diagnosed with hypertension and treated in specialist healthcare facilities. As a research tool, a questionnaire prepared on the basis of recent literature was used.

RESULTS

The vast majority of respondents (72.7%) declared that they were regularly taking antihypertensive drugs. The proportion of patients regularly taking antihypertensive drugs was higher in patients treated with monotherapy than with polytherapy (48.5% vs. 24.2%). Among the methods of non-pharmacological treatment of hypertension, the most accepted lifestyle change in the study population was smoking cessation (83.8% of respondents) and reduction of salt consumption (64.5% of respondents), and the least acceptable lifestyle change was maintaining proper body weight by eating a low calorie diet (30.6% of respondents).

CONCLUSIONS

Adolescents with hypertension adhere in varying degrees to medical recommendations related to the hypertension treatment. The available literature indicates that the currently effective way to improve cooperation with the patients is education.

Aliskiren - an alternative to angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in the therapy of arterial hypertension

There has been enormous progress in antihypertensive therapy over the last few decades. However, the management of arterial hypertension is still insufficient and more efforts are needed to improve both non-pharmacological and pharmacological treatment of this widely prevalent disease. Renin-angiotensin-aldosterone system (RAAS) inhibition is crucial both for blood pressure (BP) control and for prevention of organ damage or its development in patients with hypertension. Angiotensin-converting enzyme inhibitors and/or sartans block RAAS incompletely. Aliskiren is one of the novel drugs that has been introduced to antihypertensive therapy recently. Up to now no trial has confirmed that aliskiren is efficacious in reducing cardiovascular events. Double RAAS blockade with aliskiren was not always safe. This review article presents the current view on the place of aliskiren in the therapy of arterial hypertension.

Economic aspects of hypertension treatment in Poland

INTRODUCTION

The aim of this study was to assess the costs associated with mild hypertension (HTN) in Poland and to compare the costs of 3-year ambulatory care for those diagnosed with mild HTN (group A) and those diagnosed with mild HTN and comorbidities (group B).

MATERIAL AND METHODS

The researchers undertook a retrospective study of a group of 120 patients treated for 3 years (2006-2008) (60%, n = 72 women and 40%, n = 48 men), taking into account the broadest possible social perspective. Medical and non-medical direct costs as well as indirect costs were calculated.

RESULTS

The total costs of the 3-year pharmacotherapy in group A equalled 49,985.65 EUR, or 833.09 EUR per patient, whereas in group B the costs were twice as high: 105,691.55 EUR in total or 1,761.53 EUR per patient. Indirect costs for group A patients totalled 3,468.80 EUR (578.13 EUR per patient) and 4,579.20 EUR for group B patients (572.40 EUR per patient). Total direct costs (medical and non-medical) and indirect costs for group B patients were much higher, amounting to 130,228.14 EUR and 2,666.55 EUR per patient, which was double the costs in group A, where costs were 74,184.96 EUR and 1,756.73 EUR per patient.

CONCLUSIONS

The costs of HTN treatment in Poland are very high and are growing, like in other countries. Potential solutions include developing better patientdoctor communication to improve compliance, and increasing the chances of more effective and less expensive therapy by prescribing cheaper generic drugs, limiting polypharmacy and improving availability of novel therapeutic methods.

Analysis of direct costs of hypertension treatment among adolescents in Poland

In adolescents, arterial hypertension (AH) is diagnosed much more frequently than previously thought--it affects 3.2% of the population aged 11-18. In Poland, at present, there are no cost analyses of treatment arterial hypertension among adolescents. The aim of the conducted studies was to analyze direct medical and non-medical costs in the time horizon of one calendar year (2010) of AH treatment in adolescents in Poland. A retrospective study from the societal perspective was based on data from 480 patients medical history cards obtained from the archives of the hospital. From this group, according to the criteria for inclusion in the study, a research group was selected consisting of 36 patients aged 16-18 years, with a diagnosed and treated hypertension. Analysis covered direct medical costs (costs of pharmacotherapy, doctors' visits and laboratory tests, hospitalization) and direct non-medical costs (cost of transport to the outpatient clinic). Average annual cost of hypertension treatment per patient was 89.96 Euro. The largest part of the structure of total costs related with hypertension treatment in adolescents in Poland were the costs of medical consultation with lab tests and diagnostic examinations--35.04% and pharmacotherapy costs--32.95%, with hospital stays rating somewhat lower with 19.12%, and the smallest part were the costs of the patient's transportation to the hypertension outpatient clinic--12.89%. Early identification of risk factors of such cardiovascular diseases as hypertension as early as in the developmental age, and their subsequent elimination, should be considered a good investment in the reduction of costs associated with hypertension treatment in adulthood.

Comparative studies on promotion of health and life style of hospital staff in Sweden and Poland

INTRODUCTION

Recently, an increase has been observed in the number of patients suffering from diseases which are the consequence of an anti-health life style; therefore it is necessary to undertake proper actions in this area, including those addressed to hospital staff.

OBJECTIVES

1) Comparison of self-reported state of health and life style between hospital staff in Sweden and Poland, and the motivation of these employees to change the to-date life style for one that is more health promoting. 2) Presentation, based on Swedish experiences in the field of health promotion in hospitals, of the possibilities to implement these changes in Polish conditions.

MATERIAL AND METHOD

The study covered the staff from the following hospitals: 1) hospitals in Östergötland County, Sweden, and 2) the Ludwik Perzyna Regional Polyclinical Hospital in Kalisz, Poland. The studies were conducted in parallel in Sweden and in Poland during the fourth quarter 2010. The research instrument was a questionnaire form.

RESULTS

The following measures should be undertaken by the staff of Polish hospitals: an increase in the consumption of fruit and vegetables, physical activity, organization of workshops aimed at the shaping of skills of coping with stress and relieving stress, assistance in reducing body weight and increasing physical activity. Obligatory breaks at work should be introduced for the consumption of meals and intake of beverages, including water, promotion of fluid replacement would reduce fatigue. An obligatory lunchtime would allow each employee to consume a decent meal, and consequently have respite away from one's own work activities. In order to have a well-functioning staff an employer should, in his/her own interest, decrease potential sick absenteeism, provide incentives for motor activity, e.g. by the organization of groups, reduction of weekly working time on behalf of documented physical activity, or financial support for the purchase of tickets for various forms of physical exercises. Promotion of collective exercise, e.g. common nordic walking for 30 min. during lunch, competition in the largest number of steps made. Promotion of healthy nutrition by the preparation of recipes for meals, several exemplary healthy meals in the form of a healthy alternative breakfast. During this event, a basket of fruit is provided, instead of cakes and sweets.

CONCLUSIONS

1) The life style of the staff of health care facilities is more health promoting in Sweden than in Poland. 2) It is possible to change the life style of employees of health care facilities into one that is more health promoting. Changes in this area have been made in Sweden with a great success; therefore, it is worthwhile implementing in Poland these Swedish experiences which may function also in Polish conditions. 3) The foundations of health promotion in enterprises have been known for a long time; however, considering the fact that the comparative studies show that these foundations are more advanced in Sweden, it is necessary that Polish employers devote more attention to this problem, and become interested in Swedish experiences in this area.

Dietary behaviours of adolescents from urban and rural areas in the district of Szamotuły--a preliminary study

INTRODUCTION

Numerous factors and conditions affect the dietary behaviours of the young population. Urban-rural differences may also influence the lifestyle of adolescents, including diet.

AIM

To describe dietary behaviours of two young populations: living in urban or rural areas in the district of Szamotuły (a city with a population of 19,000 inhabitants).

MATERIAL AND METHODS

116 adolescents aged 15-17 years were included to this preliminary study and asked to answer questions concerning health and lifestyle.

RESULTS

No statistically significant difference was detected in the number of meals eaten daily, and 3 meals a day was the most frequent answer (45.9% in the rural group and 32.7% in the urban group). About 41.0% of rural subjects and 50.9% of urban ones admitted that they ate fresh fruit and vegetables every day. There was no statistically significant difference in the medium consumption frequency of fresh fruit, vegetable, fish, sweets and salty snacks.

CONCLUSIONS

1. Between rural and urban adolescents no statistically significant differences were observed in dietary behaviours concerning medium number of meals eaten daily, medium frequency of fresh fruit and vegetable consumption, medium monthly frequency of fish consumption, medium weekly frequency of consumption of sweets and salty snacks. 2. More than a half of the young rural dwellers preferred more salty meals in contrast to over 56% of urban youths who preferred less salty meals. Both urban and rural adolescents most often declared that eat sweets and salty snacks daily. 3. There is a great need to change the dietary habits of teenagers, especially in avoiding an over-intake of high fat and high energy products, in order to reduce the rising prevalence of obesity among adolescents.

The way of serum chromium utilization may contribute to cardiovascular risk factors in centrally obese persons

INTRODUCTION

Obesity-related disturbances are considered to be risk factors for cardiovascular disease (CVD). Chromium is shown to improve carbohydrate and lipid metabolism. Conflicting data on effects of chromium supplementation in humans are published. The aim of the study was to assess the concentrations of serum chromium during the 75-g oral glucose tolerance test (OGTT) in obese persons.

MATERIAL AND METHODS

Fourty-eight centrally obese Caucasians, apparently healthy, using neither special diet nor mineral supplementation, were enrolled in the study. During the OGTT, 0-min and 120-min concentrations of plasma glucose (G 0', G 120'), serum insulin (Ins 0', Ins 120') and chromium (Cr 0', Cr 120') were determined. Plasma lipids, apolipoproteins A and B, and serum uric acid were measured at 0 min only. For parameters assessed during the OGTT, the difference D = [(120' concentration) - (0' concentration)] was calculated. Contradictory tendencies of Cr 120' were observed; thus the difference of serum chromium concentrations, DCr = [(Cr 120') - (Cr 0')], was used to establish the positive DCr group with DCr > 0 (PosDCr: n= 24; 9 male/15 female) and the negative DCr group with DCr < 0 (NegDCr: n= 24; 8 male/16 female).

RESULTS

The studied groups were comparable as far as their metabolic parameters are concerned, except higher G 120' (p= 0.043) and DG (p = 0.048), and lower Cr 120' (p < 0.000), which were observed in the NegDCr group. The NegDCr persons showed inverse correlations between Cr 0' and systolic and diastolic blood pressure.

CONCLUSIONS

We suggest that the studied centrally obese persons differed in chromium metabolism. In subjects "consuming" Cr during the OGTT, chromium status may be associated with increased risk for CVD.

Estimation of physical activity and prevalence of excessive body mass in rural and urban Polish adolescents

Excessive body mass and sedentary lifestyle are well-known factors for cardiovascular risk, which when present in the young population may have significant health consequences, both in the short- and long-term. The aim of the study was to evaluate the prevalence of overweight, obesity, and sedentary lifestyle in two teenage populations living in an urban or rural area. An additional aim was to compare their physical activity. The study was designed and conducted in 2009. The study population consisted of 116 students aged 15-17 years - 61 males (52.7%) and 55 females (47.3%), randomly selected from public junior grammar schools and secondary schools in the Poznań Region. There were 61 respondents from a rural area - 32 males (52.5%) and 29 females (47.5%), whereas 55 teenagers lived in an urban area - 29 males (47.5%) and 26 females (47.3%). Students were asked to complete a questionnaire, which was especially prepared for the study and contained questions concerning health and lifestyle. A basic physical examination was carried out in all 116 students, including measurements of the anthropometric features. Calculations were performed using the statistical package STATISTICA (data analysis software system), Version. 8.0. When comparing these two populations, no statistically significant differences were detected in the ratio of weight-growth, with the exception of the fact that the urban youths had a larger hip circumference (97.1 v. 94.3 cm, p<0.05). In the group of urban students there were also significantly more subjects with excessive body weight (27.3% v. 24.6%, p<0.05), with a predominant proportion of obese students (60%). There were significantly more male obese individuals (66.7%). In the population of rural teenagers, obesity rate did not differ statistically significantly from the percentage of overweight (11.5% v. 13.1%, p>0.05), the problem of excessive weight affected both sexes in a similar proportion (25% boys and 24.1% girls, p>0.05). In this paper it is shown that there were differences concerning physical activity of teenagers living in urban and rural areas. Urban students much more often declared an active lifestyle (72.7% v.42.6%, p<0.05), used a variety of additional forms of activity (not counting compulsory physical education classes).

[Chronic intestinal ischemia--not rare cause of abdominal pains--case description]

Chronic intestinal ischemia is a diagnostic problem for the physicians from internal department as well for the surgeons. The clinical manifestation of this disease is not clear and the symptoms are similar to many other disorders. This requires from the physician a wide knowledge and many-sided diagnostic process. The success depends also on the good cooperation between radiologist and vascular surgeon. The authors presents the case of 59-aged patient with occlusion of superior mesenteric artery. After the angioplasty there was a complete relief of ischemic symptoms.

Circulating serum adiponectin concentrations do not differ between obese and non-obese caucasians and are unrelated to insulin sensitivity

Reduced serum levels of adiponectin in obesity and insulin resistance seem paradoxical, since adipose tissue is the only source of adiponectin, and reports on that subject are contradictory. The aim of this study was to investigate the concentrations of adiponectin in non-obese and obese normoglycemic humans, and to determine the correlation between adiponectin and HOMA index of insulin sensitivity. Based on the WHO definition of obesity, 145 obese subjects and 49 non-obese controls (aged 20-55 years) were studied. The serum adiponectin concentrations did not differ between subjects and controls (p=0.6398) and were not correlated with HOMA index (r=-0.0211; p=0.8048, and r=-0.0523; p=0.4757, for subjects and controls, respectively). Adiponectin was not correlated with HOMA index in females (r=-0.0521; p=0.6546, and r=-0.0825; p=0.3981, for female subjects and controls, respectively) as well as in males (r=0.0033; p=0.9791, and r=0.0123; p=0.9131, for male subjects and controls, respectively). These results lead to the conclusion that neither the concentrations of adiponectin differ between obese and non-obese humans, nor does any relationship between adiponectin concentration and insulin sensitivity exist.

[The influence of ACE-inhibitor on endothelin concentration and some metabolic parameters in young hypertensives]

The aim of this study was to assess the influence of trandolapril on blood pressure and ET-1 plasma activity in young patients with essential mild-to-moderate hypertension.

MATERIAL AND METHODS

19 persons with essential mild-to-moderate hypertension were enrolled into the study: the average age of this group was 17,6 +/- 1,4 years. The blood pressure and serum concentration of ET-1 in plasma were measured before enrolling and after 42 days of trandolapril (2 mg per day) therapy. The concentration of endothelin-1 was measured using RIA method.

RESULTS

In the studied group, after trandolapril therapy SBP was reduced from 142.6 +/- 9,7 mmHg to 129.3 +/- 8,4 mmHg (p<0,003), DBP from 85.7 +/- 6,9 mmHg to 79.8 +/- 8,6 mmHg (p<0,01). The average serum concentration of endothelin-1 was: before therapy 9,33 +/- 1,9 fmol/ml and after therapy 8,96 +/- 2,2 fmol/ml (non-significant).

CONCLUSIONS

1. Young hypertensives treated with trandolapril (ACEI) showed significant decrease of SBP and DBP 2. 6-weeks trandolapril therapy was associated with the reduction of serum concentration of ET-1, but without statistical significance.

[Expression of chemokine receptor CCR5 in patients with type 2 diabetes]

Overexpression of chemokine receptors might contribute to the initiation of atherosclerosis, due to promotion of monocyte migration to the subendothelial space which is considered as an initiating mechanism in the natural history of atherosclerosis. The CCR5 receptor is one of the chemokine receptors present on peripheral T lymphocytes, monocytes and macrophages.

OBJECTIVE

The aim of the study was to determine the expression of CCR5 receptor on peripheral blood mononuclear cells (PBMC) in patients with type 2 diabetes.

MATERIAL AND METHODS

14 patients with type 2 diabetes and 6 healthy subjects as a control were included to the study. We evaluated the density of the CCR5 receptor on peripheral blood mononuclear cells by flow cytometric analysis by use of LSR Cytofluorograf System (Becton Dickinson Co.).

RESULTS

There was significantly higher density of the CCR5 receptor on PMBC in diabetic subjects when compared to the controls.

CONCLUSIONS

(1) Patients with type 2 diabetes present overexpression of the CCR5 receptor on peripheral blood mononuclear cells. (2). Overexpression of the CCR5 receptor should be considered as a factor that promotes the development of atherosclerosis in diabetic patients.

[The role of adiponectin in pathogenesis of insulin resistance and metabolic syndrome]

Metabolic syndrome occurs in about 25% of the adult population in industrialised countries. The pathogenesis of this syndrome is associated with insulin resistance. There are growing evidence that proteins produced in adipose tissue can play a role in development of insulin resistance. One of them is adiponectin (APM1), that circulates in human plasma at high level (5-30 microg/ml). A reduction in APM1 expression is closely associated with insulin resistance in animal models and in studies in humans. APM1 correlates with typical features of metabolic syndrome: BMI, WHR, total cholesterol, HDL, LDL and triglyceride levels, glucose, insulin, degree of insulin resistance in hyperinsulinemic-euglycemic clamp, blood pressure, hyperuricemia. There are some hypotheses that in the future therapy with APM1 may play a role in reversing insulin resistance in many disorders.

[Assessment of blood pressure and endothelin-1 plasma concentration in young, hypertensive patients after treatment with angiotensin converting enzyme inhibitor]

BACKGROUND

Endothelin (ET) is the strongest endogenic substance causing vasoconstriction. The aim of this study was to assess the influence of ACEI therapy on serum concentration of ET-1 plasma activity in young patients with essential mild-to-moderate hypertension.

DESIGN AND METHODS

19 persons with essential mild-to-moderate hypertension were enrolled into study (14 male and 5 female). The average age of this group was 17.6+/-1.4 years. The patients were untreated or there was a 7 day wash out period. The blood pressure and serum concentration of ET-1 plasma were measured before enrolling and after 6 weeks of trandolapril (2 mg per day) therapy. The concentration of endothelin-1 was measured using RIA methods.

RESULTS

In analyzed group there was a significant both SBP and DBP lowering after the ACEI therapy. SBP was reduced from 142.6+/-9.7 to 129.3+/-8.4 mmHg (p<0.003), DBP from 85.7+/-6.9 to 79.8+/-8.6 mmHg (p<0.01). The average serum concentration of endothelin-1 was: before treatment 9.33+/-1.9 fmol/ml and after therapy 8.96+/-2.2 fmol/ml.

CONCLUSION

The treatment with ACEI drug (trandolapil) induced the significant decrease of SBP and DBP in young hypertensives. 6-weeks trandolapril therapy was associated with the reduction of serum concentration of ET-1, but not statistically significant.

[Hypotensive effectiveness of therapy combined enalapril and nitrendipine and influence on the quality of life]

It has been proved that effectiveness of monotherapy in mild hypertension is about 50%; in the other half of patients the dose of previously used drug should be increased or combined therapy should be recommended. THE AIM OF THE STUDY was to compare treatment with angiotensin convertase enzyme inhibitor--ACE-I (enalapril 10 mg bid--group 1) to therapy with ACE-I combined with calcium antagonist (enalapril 5 mg bid + nitrendipine 20 mg qd--group 2).

MATERIAL AND METHODS

In a prospective, open, randomised crossover study we assessed 44 hypertensive subjects (17 women, 27 men), aged 35-69 years (mean age 48.6 years) with poorly controlled hypertension treated with enalapril 5 mg twice daily. Mean initial systolic blood pressure was 150.8 < or = 9.9 mmHg, diastolic 94.7 +/- 5.3 mmHg respectively. The influence of the treatment regimen on the quality of life (QoL) was estimated by a questionnaire.

RESULTS

The effectiveness of both used procedures did not differ statistically--in both groups mean blood pressure reduction was similar (14/8 mmHg in 4 weeks), also percentage of patients with well controlled hypertension (about 50%) did not differ significantly. In the group with changes regimen from monotherapy to combined therapy the improvement of systolic blood pressure was found to be statistically significant (p<0.05); in the case of combined therapy replaced with monotherapy such an improvement was not observed. In the subgroup with the isolated systolic hypertension combined therapy was considerably more effective. The improvement of QoL was noted in both groups, mainly in the initial phase of the study.

CONCLUSION

In mild hypertension ACE-I and calcium antagonist combination is effective in blood pressure reduction and in the improvement of the quality of life. Nitrendipine in a dose 20 mg in an once daily regimen is a potent and safe hypotensive agent, particularly in isolated systolic hypertension.

[The effect of analysed hypotensive drugs on certain metabolic parameters]

The aim of this study was to assess the influence of 3 hypotensive drugs on the metabolic disorders: dyslipidemia, insulin resistance, hyperuricemia. There were 39 patients aged 20-55, with mild-to-moderate essential hypertension. The patients with other serious diseases or treated earlier with cholesterol or uric acid lowering drugs were excluded. Patients were divided into 3 groups, each was treated during 8 weeks with one drug: gr 1--trandolapril (T), gr 2--felodipine ER (F), gr 3--rilmenidine (R). Glucose and insulin in oral glucose tolerance test, I/G proportion, serum lipids and uric acid were tested before and after therapy. The therapy did not influence lipid parameters: LDL, HDL, triglyceride. In the T group there could be observed a significant reduction of total cholesterol value. Examined drugs did not induce changes in serum carbohydrate. The significant reduction of serum uric acid could be observed only after F therapy. Analysed drugs are very useful in therapy of hypertension with metabolic disorders.